Thousands of elderly patients are being forced to pay up to £32 for an ambulance service to take them to hospital.

Many cannot afford the fees and are cancelling their appointments.

The pensioners are victims of a cost-cutting exercise by Brighton and Sussex University Hospitals NHS Trust which says too many people are using the Patient Transport Service (PTS) "inappropriately". From now on, only those assessed as unable to walk or travel by car will be allowed to use the non-urgent service.

The changes were revealed in a leaked memo from the trust and an anonymous note from concerned staff at a doctor's surgery in Cuckfield which said older people have been cancelling appointments because they cannot afford the fares of up to £32 to get there.

The memo from the trust's general manager Gareth Hall, sent to consultants, GPs and hospital administrators, said patient escorts cannot use the service unless there is a clinical necessity.

The move is a further blow to the elderly, following the BBC Panorama documentary which revealed a catalogue of neglect in the care of older patients at the Royal Sussex County Hospital in Brighton. The cutbacks came to light at a meeting of Mid Sussex District Council and have outraged councillors and groups which represent older people.

The trust spends £2.5 million a year on the PTS, which is provided by Sussex Ambulance NHS Trust.

Trust managers insist the cutbacks are necessary following an "unsustainable rise in demand" for the transport services and considerable overspend.

Critics say the rise is unavoidable because hospital services are split across sites in Brighton and Haywards Heath.

Councillor Paddy Henry, who was at the council meeting, said: "Wait till the people of Brighton realise they are now going to have to drag themselves across the Downs to get a hip replacement. They'll have to shuffle up here on a walking frame unless they're able to pay for transport. There'll be 7,000 to 8,000 people coming up from Brighton a year for planned surgery."

Brian Wyld, Brighton-based regional development manager for Help the Aged, said patient transport was an essential service.

He said: "It is a soft target for cutbacks and I suspect has been done without any real realisation of the consequences. Some of these people will not have any other option than jumping on a bus.

Others already rely on neighbours and never take up what they are entitled to. The implications are vast but it seems once again, budgets instead of people, come first."

Dorothy Engmann, director of Age Concern in Brighton, said it was worrying elderly patients were being prevented from taking an escort with them when many needed help and reassurance from a friend.

Councillor Terry Gillard said he was "disgusted" at the changes.

A statement from the trust said people with medical needs would be able to continue with the service free of charge.

It said although inappropriate use of the PTS had contributed to a rise in costs it was "by no means the driving factor" in tightening up the criteria for use.

Last night the trust said they could not provide figures for the number of people using the PTS or the estimated savings.

Last week the trust was issued with a zero-star performance rating for the second year running.